Role of pharmacists in management of patients with thyroid disorders

  • Ana Homšek University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetic and Clinical Pharmacy
  • Maša Roganović University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetic and Clinical Pharmacy
  • Milena Kovačević University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetic and Clinical Pharmacy
  • Marija Jovanović
Keywords: hypothyroidism, hyperthyroidism, pharmaceutical care, patient counseling

Abstract


Thyroid dysfunction is one of the most prevalent endocrine disorders, especially common in female patients. If patients are not diagnosed in time or adequately treated, the patients’ quality of life can be significantly impaired and additional health problems may occur, considering the key roles of thyroid hormones in the body. Therefore, it is necessary to raise awareness about the importance of recognition of symptoms that may indicate a potential problem with the thyroid gland and help to identify possible causes. For patients who are already being treated with levothyroxine (hypothyroidism), or thiamazole, carbimazole or propylthiouracil (hyperthyroidism), it is necessary to point out the necessity of proper, regular use of the drugs and implementation of accompanying nonpharmacological measures, as well as the potential for the occurrence of adverse reactions and interactions with other drugs or food. A significant role in the mentioned activities should be played by the pharmacist, as the most accessible member of the health team, who can, if necessary, refer the patient to a doctor for diagnosis, monitor the effectiveness and safety of the therapy, and provide appropriate patient counseling.

References

1. Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-31.

2. Kalhan A, Page MD. Thyroid and parathyroid disorders. In: Whittlesea C, Hadson K, editors. Clinical Pharmacy and Therapeutics (6th edition). London: Elsevier; 2019; p. 744-761.

3. Wiffen P, Mitchell M, Snelling M, Stoner N. Thyroid disorders. In: Oxford Handbook of Clinical Pharmacy (3rd edition). Oxford: Oxford University Press; 2017; p. 495-503.

4. Martin CM. Thyroid dysfunction and the elderly patient: a primer for pharmacists. Consult Pharm. 2012;27(10):682-8.

5. Chiovato L, Magri F, Carle A. Hypothyroidism in context: where we've been and where we're going. Adv Ther. 2019;36(Suppl 2):47-58.

6. Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primers. 2022;8(1):30.

7. Davies TF, Andersen S, Latif R, Nagayama Y, Barbesino G, Brito M, et al. Graves' disease. Nat Rev Dis Primers. 2020;6(1):52.

8. Hanley P, Lord K, Bauer AJ. Thyroid disorders in children and adolescents: a review. JAMA Pediatr. 2016;170(10):1008-1019.

9. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-43.

10. McRobbie D, Webb D, Davies G. Clinical pharmacy practice. In: Whittlesea C, Hadson K, editors. Clinical Pharmacy and Therapeutics (6th edition). London: Elsevier; 2019; p. 2-13.

11. Wiffen P, Mitchell M, Snelling M, Stoner N. Concept and core elements of pharmaceutical care. In: Oxford Handbook of Clinical Pharmacy (3rd edition). Oxford: Oxford University Press; 2017; p. 34-37.

12. Pharmaceutical Care Network Europe Association [Internet]. Pharmaceutical Care Network Europe Classification for Drug Related Problem V9.1; 2020 [cited 2022 August 15]. Available from: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf.

13. Berenguer B, La Casa C, de la Matta MJ, Martin-Calero MJ. Pharmaceutical care: past, present and future. Curr Pharm Des. 2004;10(31):3931-46.

14. Dong BJ. Pharmacist involvement in a thyroid clinic. Am J Hosp Pharm. 1990;47(2):356-61.

15. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-751.

16. Colucci P, Yue CS, Ducharme M, Benvenga S. A review of the pharmacokinetics of levothyroxine for the treatment of hypothyroidism. Eur Endocrinol. 2013;9(1):40-47.

17. Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, et al. 2013 ETA Guideline: management of subclinical hypothyroidism. Eur Thyroid J. 2013;2(4):215-28.

18. Duntas LH, Jonklaas J. Levothyroxine dose adjustment to optimise therapy throughout a patient's lifetime. Adv Ther. 2019;36(Suppl 2):30-46.

19. FDA levothyroxine [Internet]. Food and Drug Administration prescribing information for EUTHYROX® (levothyroxine sodium) tablets [cited 2022 July 25]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021292s004,021292s005,021292s006lbl.pdf.

20. SmPC levothyroxine [Internet]. Summary of Product Characteristic for levothyroxine (eMC) [cited 2022 July 25]. Available from: https://www.medicines.org.uk/emc/product/5806/.

21. Virili C, Antonelli A, Santaguida MG, Benvenga S, Centanni M. Gastrointestinal malabsorption of thyroxine. Endocr Rev. 2019;40(1):118-136.

22. Schaffler A. Hormone replacement after thyroid and parathyroid surgery. Dtsch Arztebl Int. 2010;107(47):827-34.

23. Benvenga S, Carle A. Levothyroxine formulations: pharmacological and clinical implications of generic substitution. Adv Ther. 2019;36(Suppl 2):59-71.

24. Holmes DR Jr, Becker JA, Granger CB, Limacher MC, Page RL 2nd, Sila C, et al. ACCF/AHA 2011 health policy statement on therapeutic interchange and substitution: a report of the American College of Cardiology Foundation Clinical Quality Committee. J Am Coll Cardiol. 2011;58(12):1287-307.

25. Soldin OP, Soldin SJ, Vinks AA, Younis I, Landy HJ. Longitudinal comparison of thyroxine pharmacokinetics between pregnant and nonpregnant women: a stable isotope study. Ther Drug Monit. 2010;32(6):767-73.

26. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76-94.

27. Haddad HM. Rates of I 131-labeled thyroxine metabolism in euthyroid children. J Clin Invest. 1960;39:1590-4.

28. Santini F, Pinchera A, Marsili A, Ceccarini G, Castagna MG, Valeriano R, et al. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab. 2005;90(1):124-7.

29. Ling H, Patel A, Park J, Bhave VS. Thyroid hormones, iodine and iodides, and antithyroid drugs. In: Ray SD, editor. Side Effects of Drugs Annual. Amsterdam: Elsevier; 2019; p. 481-492.

30. Abdi H, Amouzegar A, Azizi F. Antithyroid Drugs. Iran J Pharm Res. 2019;18(Suppl1):1-12.

31. SmPC thiamazole [Internet]. Summary of Product Characteristic for thiamazole (ALIMS) [cited 2022 August 10]. Available from: https://www.alims.gov.rs/doc_file/lekovi/smpc/515-01-04554-18-001.pdf

32. SmPC propylthiouracil [Internet]. Summary of Product Characteristic for propylthiouracil (ALIMS) [cited 2022 August 10]. Available from: https://www.alims.gov.rs/doc_file/lekovi/smpc/515-01-02069-18-001.pdf.

33. Liu J, Fu J, Xu Y, Wang G. Antithyroid drug therapy for Graves' disease and implications for recurrence. Int J Endocrinol. 2017;2017:3813540.

34. SmPC carbimazole [Internet]. Summary of Product Characteristic for carbimazole (eMC) [cited 2022 August 10]. Available from: https://www.medicines.org.uk/emc/product/10328.

35. Kahaly GJ, Bartalena L, Hegedus L, Leenhardt L, Poppe K, Pearce SH. 2018 European thyroid association guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018;7(4):167-186.

36. Kampmann JP, Hansen JM. Clinical pharmacokinetics of antithyroid drugs. Clin Pharmacokinet. 1981;6(6):401-28.

37. Azizi F, Abdi H, Amouzegar A, Habibi Moeini AS. Long-term thionamide antithyroid treatment of Graves' disease. Best Pract Res Clin Endocrinol Metab. 2022:101631. doi: 10.1016/j.beem.2022.101631.

38. Benker G, Reinwein D. Pharmacokinetics of antithyroid drugs. Klin Wochenschr. 1982;60(11):531-9.

39. Amisha F, Rehman A. Propylthiouracil (PTU) [Internet]. StatPearls [cited 2022 August 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549828/.

40. Skellern GG, Knight BI, Otter M, Low CK, Alexander WD. The pharmacokinetics of methimazole in pregnant patients after oral administration of carbimazole. Br J Clin Pharmacol. 1980;9(2):145-7.

41. E-Lactancia [Internet]. Association for Promotion and Cultural and Scientific Research of Breastfeeding, Spain [cited 2022 August 15]. Available from: www.e-lactancia.org.

42. Crooks J, O'Malley K, Stevenson IH. Pharmacokinetics in the elderly. Clin Pharmacokinet. 1976;1(4):280-96.

43. Azizi F. The safety and efficacy of antithyroid drugs. Expert Opin Drug Saf. 2006;5(1):107-16.

44. Tan S, Chen L, Jin L, Fu X. The efficiency and safety of methimazole and propylthiouracil in hyperthyroidism: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021;100(30):e26707.

45. Singh G, Correa R. Methimazole [Internet]. StatPearls [cited 2022 August 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545223/.

46. British Thyroid Foundation [Internet]. Thyroid and diet factsheet [cited 2022 August 15]. Available from: https://www.btf-thyroid.org/thyroid-and-diet-factsheet.

47. Danailova Y, Velikova T, Nikolaev G, Mitova Z, Shinkov A, Gagov H, et al. Nutritional management of thyroiditis of Hashimoto. Int J Mol Sci. 2022;23(9):5144. doi: 10.3390/ijms23095144.

48. Ihnatowicz P, Drywien M, Wator P, Wojsiat J. The importance of nutritional factors and dietary management of Hashimoto's thyroiditis. Ann Agric Environ Med. 2020;27(2):184-193.

49. Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hell J Nucl Med. 2017;20(1):51-56.

50. Pirola I, Rotondi M, Cristiano A, Maffezzoni F, Pasquali D, Marini F, et al. Selenium supplementation in patients with subclinical hypothyroidism affected by autoimmune thyroiditis: Results of the SETI study. Endocrinol Diabetes Nutr (Engl Ed). 2020;67(1):28-35.

Published
2022/10/31
Section
Professional articles